CareSource
Job Summary:
The Director, Provider Contracting executes contracting strategy, develops provisions based on cost, quality/analysis and monitors key metrics.
Essential Functions:
Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting
Ensure an ongoing high level of staff engagement, empowerment and development
Responsible for provider recruitment, implementation of contracts
Responsible of contracts and testing, initiating set‑up, post configuration testing, maintenance and audit of claims system
Create contract language and review with legal to develop approved contract templates
Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
Implement an efficient and effective process to on‑board new providers; ensure network is adequate (access for members), cost‑effective, competitive and stable, and meets corporate & regulatory requirements
Responsible for ensuring all regulatory requirements for provider network are met
Perform gap analysis to ensure no gaps and/or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed
Responsible for access grievance intake, analysis and performance improvement initiatives
Participate in training sessions for providers and staff as appropriate
Support the contracting requirements of the corporation for geographic regions and products
Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
Assist with development and review of payment policies and provider notifications
Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
Perform any other job related instruction as requested
Education and Experience:
Bachelor's degree in a healthcare related field, or equivalent work experience is required
Master's Degree or equivalent work experience is preferred
Minimum three (3) years of contract negotiation experience is required
Minimum three (3) years of management experience is required
Managed care experience is highly preferred
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Outlook Word, and Excel
Knowledge of Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact‑based decision making
Effective oral and written communication skills
Critical listening and thinking skills
Training/teaching skills
Time management skills
Licensure and Certification:
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
General office setting, noise level is generally quiet to moderate
Perform reasonable travel, up to 30% to fulfill the duties of the position
Compensation Range: $132,900.00 - $232,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well‑being and offer a substantial and comprehensive total rewards package.
Compensation Type: Salary
Competencies:
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
#LI-SW2
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Essential Functions:
Conduct annual effectiveness review of contracting strategies; ensure corporate compliance with all contracting
Ensure an ongoing high level of staff engagement, empowerment and development
Responsible for provider recruitment, implementation of contracts
Responsible of contracts and testing, initiating set‑up, post configuration testing, maintenance and audit of claims system
Create contract language and review with legal to develop approved contract templates
Administer provider contracts, terms, reimbursement rates, etc., in a manner that complies with corporate policies
Implement an efficient and effective process to on‑board new providers; ensure network is adequate (access for members), cost‑effective, competitive and stable, and meets corporate & regulatory requirements
Responsible for ensuring all regulatory requirements for provider network are met
Perform gap analysis to ensure no gaps and/or sanctions occur; identify & implement solutions that mitigate risk; development of corrective action plans as needed
Responsible for access grievance intake, analysis and performance improvement initiatives
Participate in training sessions for providers and staff as appropriate
Support the contracting requirements of the corporation for geographic regions and products
Implement performance improvement initiatives to improve Provider Satisfaction Scores incrementally on an annual basis
Assist with development and review of payment policies and provider notifications
Collaborate with appropriate personnel with process of reassignment of members related to provider terminations, as required by the state
Perform any other job related instruction as requested
Education and Experience:
Bachelor's degree in a healthcare related field, or equivalent work experience is required
Master's Degree or equivalent work experience is preferred
Minimum three (3) years of contract negotiation experience is required
Minimum three (3) years of management experience is required
Managed care experience is highly preferred
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Outlook Word, and Excel
Knowledge of Network Management Processes & Services
Ability to manage and prioritize multiple tasks, promote teamwork and fact‑based decision making
Effective oral and written communication skills
Critical listening and thinking skills
Training/teaching skills
Time management skills
Licensure and Certification:
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
General office setting, noise level is generally quiet to moderate
Perform reasonable travel, up to 30% to fulfill the duties of the position
Compensation Range: $132,900.00 - $232,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well‑being and offer a substantial and comprehensive total rewards package.
Compensation Type: Salary
Competencies:
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
#LI-SW2
#J-18808-Ljbffr